Penile cancer: is a surgical margin of 1mm safe?

Takeaway

• In the absence of lymphovascular invasion (LVI) and/or cavernosal involvement, a deep clear margin of ≥1mm is sufficient to reduces risk for local recurrence of penile squamous cell cancer (SCCp) after organ-sparing surgery (OSS).

Why this matters

• British Association of Dermatologists guidance recommends 4mm clear margin for low-risk SCCs and 6mm in high-risk SCCs.
• This study suggests local oncological control is not compromised by close excision margins, and this is a feature in which penile SCC appears to behave differently from other cutaneous SCCs.
• 620 new cases of SCCp are diagnosed in the UK each year.
• SCCp accounts for 1% of all cancer deaths in males in the UK.

Key results

• 64% had <5mm clear margin.
• Clear margin was <1mm in 16%.
• True recurrence rate was 4%.
• Median time to recurrence was 6 mos.
• 53% of local recurrences were attributed to embolic spread, with residual occult local disease accounting for 47%.
• Cavernosal involvement (P=.014) and LVI (P=.001) had a statistically significant relationship with local recurrence.
• No statistically significant difference was found between local recurrence with margins <5mm compared to margin >5mm.
• Margins <1mm did show increased risk of local recurrence (P=.0003).

Study design

• 332 patients with SCCp who had OSS with clear margins attending a UK tertiary referral centre between March 2001 and September 2012.
• Funding: none specified.

Limitations

• Single-centre study.
• Small number of recurrences.